Bioethics, although some thirty years old, is the new kid on the
block where the moral disciplines have lived for centuries. It may seem
a bit uppity, claiming to resolve old questions with fresh insights. And
like any uppity kid, it can be a tempting target for a trouncing. Snide
comments like "... bioethicists, the professionals who promise to
guide us through these troubled waters," and "self-proclaimed
bioethicists ... designated advice givers" are warnings of the
trouble to come. Now two toughies have appeared, intent on beating up
the bioethicists. Tina Stevens's Bioethics in America and Wesley
Smith's Culture of Death are book-length batterings. There is a lot
of pushing and shoving but, in my view, neither bully gets in a serious
body blow. Strangely enough, although they both are out to teach
bioethics a lesson, the lessons they want to teach are diametrically
opposed.

A sage counselor once advised a college president, "if
Professors A, B, and C (vocal members of the conservative faculty)
criticize and Professors X, Y, and Z (the liberal voices) also complain,
you are doing the right thing." Smith stands with A, B, and C and
Stevens with X, Y, and Z among the critics of bioethics. Stevens tells a
story of bioethics in which the bioethicists have become pusillanimous
opportunists, subservient apologists for the powerful medical
establishment. Smith's bioethicists, on the other hand, are
insidious infiltrators of the ancient ethics of medicine, sapping its
moral strength and injecting the poison of utilitarianism. Bioethics,
then, is both vanquished and victor, willing slave to its master, the
medical establishment, and powerful destroyer of that same
establishment. This paradox may reflect reality: I seem to recall
something in Nietschze about the power of the slave. However, I prefer
not to see a paradox at all but two analyses that begin with different
premises and carefully select the evidence that favor those premises. If
bioethics can be criticized from two such different sides, it must be
doing something right. At the same time, the virulence of the criticism
strongly suggests it is doing something that, if not entirely wrong, is
not quite right.

Tina Stevens teaches history at San Francisco State University. Her
short book is done in the historian's style, referencing documents
and constructing interpretations of the written and oral record. Three
chapters review the origins of the Hastings Center, the revision of the
definition of death and the story of Karen Ann Quinlan and the debate
over foregoing life support. She prefaces these three documentary
chapters with a thesis about the origins of bioethics in America.
Recalling the moral turmoil over the use of atomic power in the early
1950s, and the moral qualms of some biological scientists about the new
genetics in the early 1960s, Stevens situates the origins of bioethics
in the "responsible science" movement of that era. She cites
as well the major critics of technological culture, Mumford, Marcuse and
Ellul (strangely ignoring the one critic who directly challenged
technological medicine, Ivan Illich). Then, in Stevens's view, the
early bioethicists and the responsible scientists take different paths.

While responsible scientists expressed ambivalence over the social
implications of developments in physics and biology, the bioethicists
"brought to bear specific modes of reasoning and philosophical
principles on a wide range of specific medical and technological
issues" (p. 28). The early bioethicists, in the spirit of the
responsible scientists and the social critics, may have raised profound
questions about the directions of medicine and biology, but they quickly
merged into the general stream of this sort of concern: "the
dominant bioethicai posture has become not one of antagonism toward
medicine and science as players in a larger field of cultural
domination; rather it is one of modest ethical discussion about the
results of medical and scientific research" (p. 45). The attention
of bioethics is attracted toward individual dilemmas and particular
moral quandaries. By dwelling on these, bioethics gives a patina of
morality to the dominant establishments of health care and scientific
research. Stevens supports her contention by her interpretation of the
three "case histories."

The Hastings Center, founded with the intent to address in an
interdisciplinary fashion the issues raised by the new sciences, was
absorbed into existing medical and scientific world views and
frameworks. It was lured away from a piercing social and political
critique of these institutions. Although figures such as Daniel
Callahan, Paul Ramsey, and Robert Veatch at first challenged the
establishments, the need to survive within the world that they had
entered dampened their moral indignation. Stevens cites internal
documents showing Hastings's tremulous response to the complaints
that its approaches to issues were too critical. Money and prestige
flowed into Hastings to ensure its survival in proportion to its
modulation of criticism of the establishment. Despite founder Dan
Callahan's qualms, Hastings became in short time, "a
pro-technology agency, fostering quiescence over technology-induced
social issues that might otherwise 'be greeted with
hysteria'" (p. 71).

Stevens tells the stories of the redefinition of death and of the
debate over foregoing life support in the same vein. The Harvard
Committee for the Definition of Death, although ostensibly formed to
resolve the problem of sustaining organic life with technological means,
was in fact motivated by the concupiscence of surgeons to pursue their
experiments with organ transplantation, a pursuit that required the
harvesting of organs free from legal liability and ethical taint. The
ethical concerns about life support became a surrogate for the needs of
the new field of organ transplantation. This itself masked the true
ethical problem, namely, the experimental nature of the field itself, in
which patients were promised treatment but were, in effect, subjects of
the highly investigational procedures that constituted transplant
surgery at that time. In addition, transplanters worried about their own
legal liability, unprotected by a legal definition of death that would
authorize their removal of vital organs. The Harvard criteria and the
Hastings Center's endorsement of those criteria quieted public
concern and erected legal defenses. Thus "even in the midst of a
raging public controversy over human experimentation generally, the
public never prohibited organ transplantation on this score; in fact,
transplantation was facilitated by the popular and legal support of new
criteria for establishing when someone has died ... Heart
transplantation research weathered its morally questionable experimental
stage; the public allowed it to continue without turning its
practitioners into `surgical criminals'." The story of the
growth of bioethics "represents the (medical) professions endeavor
to limit potential threats to its ultimate control" (pp. 107.,
108).

The Quinlan story, in Stevens's version, makes the same point.
The daily news coverage of "America's sleeping beauty,"
tethered to life by machines, was a boon for the emerging bioethics.
Confusion over the newly defined brain death, the use of the respirator,
customary medical practice and legal constraints opened a wide field for
the wise comments and clarifications of bioethicists. However, under all
this debate, the medical establishment won another victory for its own
authority: the New Jersey Supreme Court decision, despite its fine
language about autonomy, left the final decision to physicians and to a
consulting ethics committee and made it clear that, should they choose
to terminate life support, they would be protected from civil and
criminal liability. The bioethicists had again played into the hands of
the medical establishment. Bioethical discourse had failed because, by
concentrating on the medical particulars of the case, it had
"limited analysis by overlooking the long-term political genesis
and reception of medical technology" (p. 147).

This is exactly Stevens's thesis about the fundamental failure
of bioethics. She concludes her book by stating that, "as long as
bioethics remains committed to the limited role of establishing
guidelines for the use of procedures and technologies that it largely
accepts as inevitable, it precludes itself from seeking answers to and
informing the public about how and why specific biomedical technologies
were created: by whom, or by what groups; on what criteria; for the
benefit of which group (race, class or gender), and to whose detriment?
... [B]ioethics may ultimately be successful in helping to alleviate
national anxieties (about bioethical problems) but will it ever be able
to free itself from the sources that help generate the dilemmas it seeks
to resolve?" (p. 159). Stevens is deeply disappointed that
bioethics has not lived up to its promise as a radical critique of
medical and scientific power.

Wesley Smith is a lawyer and a consumer advocate who has coauthored
four books with Ralph Nader. His Culture of Death is redolent of the
zeal of an activist lawyer. As one reviewer wrote in a Wall Street
Journal article titled, "Are You a Person or a Nonperson? The New
Bioethicists Will Decide," "Mr. Smith is not principally
concerned with the philosophical underpinnings (of bioethics). He is a
polemicist with a sharp eye for stories most likely to outrage the
reader and to make his point about the troubling direction we are headed
in." (2) The direction in which we are headed, as Smith sees it, is
a slippery slope declining from the summit, where the Western moral
tradition and the Hippocratic medical tradition long presided, into a
dark valley in which we will "come face to face with the monster
... lurking in the shadows" (p. ix). The monster is bioethics,
populated with individual monsters, "a cadre of `experts':
moral philosophers, academics, lawyers, physicians and other members of
an emerging medical intelligentsia, known generically as
`bioethicists,' ... who presume a "moral expertise of
breathtaking ambition and hubris" (p. 5). Their agenda is clear to
Smith: they are set on "dismantling traditional western values and
mores and forging a new ethical consensus based on values most people do
not share" (p. 7). Their ideology is a stark utilitarianism that
rejects the sanctity of individual life and the equality of all humans.
Smith tracks these monsters through five dark chapters: "Life
Unworthy of Life," "The Price of Autonomy,"
"Creating a Duty to Die," "Organ Donors or Organ
Farms?" And "Protecting Animals at the Expense of
People." He concludes with his own version of a "human rights
bioethics."

Smith is indeed a polemicist. He collects horror stories and
attributes them, willy-nilly, to bioethics. He tells stories of
outrageous behavior to great effect. He finds cogent quotations from the
practitioners and the critics of bioethics. He asks telling rhetorical
questions. With these techniques he is able to demonstrate, to his
satisfaction, that the mainstream of bioethics has devised a lethal
weapon against traditional western morality and Hippocratic medical
ethics. That weapon is the insidious substitution of "quality of
life" for "sanctity of life." Almost unnoticed, the value
of each unique person is depreciated into categories of lives more or
less worth living. Those less worthy of life can be sacrificed to
produce the greater good for society. Guidelines about futility or about
rationing care are the sign-posts of this depreciation. Bioethicists
have cleverly infiltrated medical ethics and health policy, gradually
turning them away from dedication and respect for individual persons
toward the destruction of the most vulnerable and undesirable among us.

Fatal Flaws

Stevens and Smith look at bioethics and see two quite different
scenes. Stevens finds subservient apologists for the medical and
scientific establishment who have long lost their radical energy; Smith
discovers insidious infiltrators into the medical and scientific
establishment who have radically changed its traditional values. A point
by point critique of the books is beyond the scope of this review.
Indeed, I have to agree with some portions of them, and I cannot deny
the accuracy of most of their quotations and stories, although I could
cavil and quibble with something on almost every page.

However, each of these books has, in my opinion, its own fatal
flaw. Professor Stevens insinuates; Mr. Smith exaggerates. Steven's
book is a historian's work and, as such, is a work of textual
interpretation. Textual interpretation is a delicate art: some texts
must be chosen without obscuring the entire context; meaning must be
inferred from converging evidences. I suspect that Stevens failed at
both these artistic tasks. Her choice of texts, in her reading of the
Hastings record, the Quinlan story, and the definition of death episode,
seem less to guide her interpretation of those events than to sustain
her a priori thesis. She insinuates rather than infers meaning in words
and events; that is, she draws conclusions, not from converging
evidence, but from that evidences that suggests the soundness of her
thesis. She builds her firm conclusions about the failure of bioethics
on ambiguous grounds.

Stevens is certain that heart transplantation rather than the
clinical problem of life support generated the brain death criteria.
Henry Beecher, author of those criteria, explicitly denied that this was
so, but Stevens simply does not believe him. Stevens affirms that the
record of the Hastings debate on the criteria demonstrates her claim,
although Dan Callahan, who sat through those debates, denies that this
was so: "The main concern ... was really the question of taking
people off of respirators." (3) Stevens is certain that the Quinlan
decision did nothing more than reaffirm medical paternalism. Her
evidence for this certainty is the final few sentences of the New Jersey
Supreme Court decision, which states, "Upon the concurrence of the
guardian and family of Karen, should the responsible attending
physicians conclude that there is no reasonable possibility of
Karen's ever emerging from her present comatose condition ... they
shall consult with the hospital `Ethics Committee' ..." Life
support systems, they said, may be withdrawn once all these parties
concur that Karen will never return to a "cognitive, sapient
state." This may be done "without any criminal or civil
liability" (p. 141). Stevens infers that those words consecrate the
autonomy and authority of physicians (though they begin with "Upon
the concurrence of guardian and family). Those few words come at the end
of an opinion that lays out a powerful case for patient and surrogate
autonomy, for medical futility, and for quality of life, but Stevens
discounts the import of all that. This is insinuation rather than
inference. Other authors give alternative interpretations of the events
in her chapters (as I have in my own Birth of Bioethics and as David
Rothman did in his Strangers at the Bedside), (4) but Stevens discounts
(not disproves) these alternative interpretations. Her interpretations
are driven less by the context and evidence than by her fundamental
ideology as a historian, namely, that all historical analysis is nothing
more than the record of power seeking to perpetuate itself. I choose to
believe that this view, though pervasive and popular in the historical
and sociological disciplines, is not the whole story.

Smith's polemic takes a different tack. It constantly employs
the rhetorical devise Pars pro Toto, the Part for the Whole. Again and
again, he cites a bioethical author who holds an opinion that is, in his
eyes, outrageous. He admits that "many bioethicists" would not
agree with the offending author, but asserts that "most"
would. Yet where are those many and those most? Here is a wonderful
example of Pars pro Toto: "Although few modern bioethicists agree
with the manner in which Binding and Hoche's euthanasia proposals
were implemented in Germany, and most would certainly object to the
authors' bigoted language, it is dear that the values expressed in
[their book] Permission to Destroy Life Unworthy of Life fit snugly
within the mainstream of the modern bioethics movement" (p. 39).
When one discounts manner and language, it becomes difficult to discern
"the mainstream." Where do George Annas, Dan Callahan, Arthur
Caplan, Alex Capron, Al Jonsen, Mark Seigler, and others, all of whom
have opposed euthanasia, fit in that "mainstream?" Again,
"many (although certainly not all) modern bioethicists are agnostic
or atheistic, a factor that colors their entire approach to issues of
life and death" (p. 22). The some (Baruch Brody, Tristram
Engelhardt, Stanley Hauerwas, Gilbert Meilander, Edmund Pellegrino, and
so on) who are not agnostic or atheistic disappear from Smith's
narrative. The overall impression is that bioethics as such is agnostic
or atheistic.

Throughout the book, Smith displays his one big Part for the Whole,
Princeton philosopher Peter Singer. Singer apparently once called
religion "mumbo jumbo" (whether he did or not I cannot verify
because instead of citing Singer, a footnote cites an article in a
conservative and not easily accessible Catholic newspaper). But then
Singer's alleged words are put into the mouths of "some
bioethicists" (p. 22). Throughout the book, Singer is almost the
single source of most outrageous views. It is easy for readers to
believe that Singer is the leading representative of bioethics. The Wall
Street Journal reviewer of Smith's book certainly got that
impression, saying what Smith does not say but dearly implies, "The
(bioethics) movement's highest High Priest is Peter Singer, who has
argued in favor of killing disabled infants." (5) Peter Singer,
despite his Princeton professorship, is not by any means the High Priest
of bioethics; indeed, he hardly belongs to the same religion. He is a
marginal and, to a great extent, a repudiated figure in the field. Yet
his constant appearance in Smith's pages makes him the spokesman
for the Whole of bioethics. Smith's entire thesis, in my view,
suffers from terminal exaggeration.

It is clear by now that I did not like either book. Several reasons
for my dislike are admittedly quite personal. The books impugn my
livelihood and my colleagues. I also feel personally slighted: although
both authors seem to know my book on the history of bioethics, in which
many differing interpretations of the same events are offered, they do
not even bother to refute me. Stevens `dismisses my work as a failure
because it does not analyze bioethics as she does (pp. 33-34).

My third and fourth reasons for dislike are more objective,
however. First, both authors (but particularly Smith) aim their
criticism not so much at bioethics, but at broader social and cultural
trends to which bioethics as a discipline is only peripheral. Smith, for
example, excoriates the animal rights movement for putting animals
before people and hindering medical research. He links this broad social
movement and its spokespersons to bioethics. For example, he begins the
chapter, "Protecting Animals at the Expense of People," with
the bold assertion, "Indeed, comparing the way we treat animals and
the way we treat people ... is something of an obsession within the
contemporary bioethics movement" (p. 189). Peter Singer is indeed
the High Priest of the animal rights movement, but his radical thesis
about the rights of animals is not an obsession with bioethicists.
Bioethicists certainly write about ethics and animals, but a review of
the 350 articles indexed under "Animal Rights" or "Ethics
and Animals" on the bioethics database Bioethicsline from 1990 to
2000 (containing some 10,000 entries) reveals that most of those
articles focus on two topics central to bioethics--research with animals
and xenotransplantation. Only about fifty of these address the animal
rights issue directly, most of them challenging rather than supporting
Singer's philosophy. This is hardly evidence for an obsession.

My final and principal reason for disliking these two books is that
I am impatient both with insinuation and with exaggeration.
Stevens's stealth bomb of insinuation makes it difficult for a
defender to know where to mobilize the defense. Should I fault her basic
historiographical thesis about the primacy of power in all human
relationships? Should I counter her fundamental claim about bioethics,
its pusillanimity before power? Should I disagree with the selectivity
of her texts? Should I reparse the same texts, seeking alternative
interpretations? Smith's exaggerations hit like a blockbuster,
obliterating all evidence of different stories, beliefs, comments, and
arguments. The smoke of his barrage obscures the view (but not the
reality) of anything good and beautiful in bioethics.

Identifying "Bioethics"

These dislikes being aired, I must say closed each book with a sigh
of relief. Neither bully had punched me out. Stevens did not convince me
that I was a failure for having worked in a failed enterprise. Smith did
not convince me that I was a monster devouring the fine ethos of
medicine and western morals. Still, even if their assaults didn't
damage my self-esteem as a bioethicist, they bothered by equilibrium.

One question raised by the books is why bioethics looks like this
(or that) to some outsiders. We bioethicists believe we do good work and
that our work is useful and widely appreciated. We believe that we are
respecters of persons, beneficent, nonmaleficent, and just. Ah, but
Wesley Smith anticipates my complaint. He says bioethicists will angrily
repudiate his description of their work. "Their self-image is that
of the ultimate rational analyzers of moral problems and facilitators of
ethical dialogue who, were pipe smoking still fashionable, would sit
back with pipe firmly in mouth and act as dispassionate mediators
between advancing medical technology and the perceived need to impose
reasonable limits on access to treatment as required by finite
resources.... That may be their self-image, but it is also a dodge and
self-deception" (pp. 5-6).

Although Paul Ramsey, one of Smith's only heroes among
bioethicists, was the only pipe-smoking bioethicist I knew, I do affirm
our identity as "rational analyzers of moral problems and
facilitators of ethical dialogue." The failure of these critics is
due to the fact that neither of them has actually been there. Like the
American planners who bombed the Chinese embassy in Belgrade, these
critics need to go to where bioethics is done and participate in its
doing. Bioethics is an academic discipline and it can be found in
textbooks, books and articles. But if one comes to know bioethics only
from its books, one has but a superficial acquaintance. As I propose in
Birth of Bioethics, bioethics is not only an academic discipline: it is
a discourse in which many people discuss, argue, and attempt to resolve
perplexities into decisions and policies. Academic bioethics, in the
classroom and in the literature, generates an endless flow of ideas and
arguments. Some of these are "far out," but that is the nature
of an academic discourse that has descended from philosophical and
theological ancestors. Disputation is the essence of these disciplines.

When academic bioethics encounters the world of clinical decisions
or public policy, however, it tempers its tone. It meets there people
who are not by nature or education "rational analyzers of moral
problems." It meets concrete conditions of institutional
possibilities, legal constraints, economic resources, cultural
perceptions, and religious beliefs. It meets, above all, the imperative
to come to a conclusion. A philosophical argument can roll on eternally;
a bioethical problem is a problem that must be resolved at a certain
time and place. Thus the bioethicists of literature become the
bioethicists of commissions, committees, and consultation, where their
words must be translated from theory into a practical discourse that all
participants can understand, and where they must react to the arguments,
concerns, and beliefs of others. The bioethicist may then realize that
the carefully honed "rational analysis" confounds or confuses
the others and that, worst of all, is not even seen by them as
"rational."

The showpieces of bioethics are the products of the public bodies
that have, from time to time, been convened by state and federal
government and by various professional groups: The National Commission
for the Protection of Human Subjects of Biomedical and Behavioral
Research, the President's Commission for the Study of Ethical
Problems in Medicine, the DHEW Ethical Advisory Board, the National
Bioethics Advisory Commission, and the bioethics commissions of New York
and of New Jersey and others. These bodies, made up of a few
bioethicists as members or consultants and of many other citizens as
well, do study the available literature, but they also go far beyond
that: they take into account general public attitudes and particular
religious beliefs. They work within a context of actual legal,
scientific, and political realities. They deliberate at great length,
listen to many opinions, draft and redraft their reports. Their work,
for all its imperfections, is American bioethics at its fullest and (in
my view) at its best.

I was puzzled and disappointed that neither Stevens nor Smith even
allude to the work of the commissions. Stevens's discussion of the
criteria for determining death would have been significantly improved
had she discussed Defining Death from the President's Commission.
Her treatment of foregoing life support would have benefited from the
careful, extensive analysis in the President's Commission document
of the same name. Smith's remarks about organ donation should have
reflected the work of the DHEW Panel on Organ Transplantation. In these
and many documents like them, academic bioethics is refracted through
the air of public discourse. Outrageous theories disappear; the moral
values of Americans appear. Arguments pro and con are devised and
displayed in as clear and logical a form as possible. Practical
possibilities for action and policy are worked out. In all of this,
academic bioethicists play a part, as "rational analyzers" and
"facilitators of ethical discourse," but their part is only
one role in the discourse. The resulting bioethics is the work of a
broader spectrum of people than Smith or Stevens include in their cast
of bioethicists.

An examination of bioethical discourse at this level will also
contradict Smith's contention that bioethics is thoroughly
utilitarian. Bioethical policy about research with human subjects, death
and dying, and organ transplantation has been consistently
nonutilitarian. Joseph Fletcher's rather naive utilitarianism and
Peter Singer's more sophisticated utilitarianism have been pushed
out of bioethical policy wherever it appeared. The deontological
perspective of Ramsey and Hans Jonas and Richard McCormick has
consistently prevailed when public bioethics discourse has issued in
policy. To be more precise (a precision that escapes Smith), the
"rule utilitarianism" that combines respect for rule and
principle with the goals of human and social thriving is the dominant
ethos of bioethics at the level of public policy. Despite its surname,
it is an ethical theory far from the rough utilitarianism that Smith
describes. Explained in careful fashion, as in Tom Beauchamp and James
Childress's Principles of Biomedical Ethics, it provides a
reasonable way of making ethical arguments in a public policy setting
and can inhibit movement toward an undiluted and ill-defined
"greater good." Even at that, the ethical theories at work
within academic and public bioethics remain diverse, and few
bioethicists are ideologically committed to any one theory in
particular.

Public bioethics also casts doubt on Stevens's thesis. She
seeks for a radical criticism of the structures of power. In her eyes, I
suppose, the commissions and committees are nothing more than
attractive, deceptive veils disguising the harsh reality of the power
establishment. Yet I believe that the National Commission's work
did radically change the practice of scientific research in America. I
also believe that the pursuit of genetic screening was modulated by the
President's Commission report on that topic. But more to the heart
of her thesis, I cannot imagine how the radical critics whom she
idolizes could ever have participated in this sort of public discourse.
They could verbally demolish the social institutions that they accused
of domination, but they had no means of actually revising or rebuilding
them. They stood outside and shouted. Illich's slashing dissection
of modern medicine and health care offered no alternative except the
exhortation that people should take care of themselves. The work of
public bioethics, while it was resigned to work within institutions, has
effected change. Sometimes marginal, perhaps, but still within the real
world where sick people, their families, their caregivers, scientists,
judges, economists, and others actually live.

Another indication that neither Smith nor Stevens has dwelt within
bioethics is their uncertainty about who the bioethicists are.
Bioethicists are "self-appointed moral experts." They are
sometimes philosophers, sometimes lawyers, sometimes physicians, and so
on. There is a "relatively small `insider' clique of elite and
powerful philosophers, academics, attorney and physician
practitioners" (Smith, p. x). They wander in and out of these
books, in a somewhat spectral way, occasionally uttering some portentous
sentence (of death, if Smith is to be believed). Some people are
identified as bioethicists because they have written or said something
about a bioethical topic. Thus Smith identifies jurisprudent Ronald
Dworkin as a bioethicist on the basis of one of his books, Life's
Dominion. Stevens deems anesthesiology professor Henry Beecher a
bioethicist. In fact, both contributed to bioethics, but I, at least,
would not give the title "bioethicist" to either of them. In
both books, long strands of narrative refer to people engaged in
bioethical discourse, inferring that what they say and do is bioethics.
People do not know who we are; indeed, we may not know who we are
ourselves.

This is dearly the result of the initial desire to create an
"interdisciplinary field of study." In the beginning, we knew
that the kinds of problems we wished to study were not abstractly
ethical, but were crammed with medical, scientific, psychological,
cultural, and economic details. Our initial job was not to pick out the
ethical piece, but to discern how the whole problem might be thought of
as ethical. That is one of the intriguing problems of ethics: practices
and institutions, not simply some segment or department of them, are
moral or immoral. Thus, lacking many polymaths, we had to invite into
the discourse many monomaths, experts in particular fields, hoping that
by arguing together some focal concept of the ethical would emerge.

Certainly, adepts in two disciplines with a strong interest in
morality--moral philosophy and moral theology--were central
participants. But even these folks were, in a sense, multiclisciplinary.
They did not sing a single song: the philosophers came with differing
training from different schools; the theologians, even from within a
particular faith, brought differing opinions about their doctrines.
Although in recent years a course of training specifically for bioethics
has appeared in many institutions, there is no central curriculum or
doctrine against which one can test a bioethicist's identity or
skills. There are a few people with "bioethics" in their job
title, but there are many others, doing medicine or law or social work,
who engage in bioethical discourse. So bioethics, diffuse as it is, is
easy to criticize. Almost any quotation or article or policy or
regulation emerging from this mix can be held up as representative of
bioethics. Given the evolution of the field and its current makeup of
personnel and programs, it is difficult to remedy this problem.
Unquestionably few, if any of us, would advocate a bioethical orthodoxy.
Still, we should be meditating on the consequences of our diffuse
identity.

The Smith and Stevens books suggest another thing we may not be
doing quite right. Bioethicists (whoever they may be) sometimes propose
provocative opinions, "the duty to die" among the more
striking of them These opinions find their way into the extensive
literature of the field. Occasionally, the provocative opinion is
noticed, inciting a response from other scholars and a whirlpool of
controversy, minor or major. Often, however, the provocative opinion
does not provoke and becomes part of the canon. This is a fault, I
believe, in a field that pretends to reach beyond its own practitioners
to the public. Peter Singer's undiluted utilitarianism, for
example, is provocative. I and many of my colleagues dispute and
repudiate his underlying theory and its applications, either in whole or
in part, and Singer does not play a central role in American bioethics.
Still, his opinions become part of the canon, by default. They should
provoke serious intradisciplinary debate and dose criticism, in root and
in branch. Only by such an examination can it be made clear that a
provocative opinion is just that, not representative of the field itself
but a legitimate challenge to critical evaluation. More vigorous
intra-disciplinary criticism would make it more difficult for authors
like Smith to blacken the whole field with one brush. I believe that we
are generally too tolerant, too willing to let the provocative opinion
slide into currency without scrutiny. Many of us who knew the great Paul
Ramsey disliked his pugnacious assaults on our ideas (I was among the
beleaguered), but perhaps some of that pugnaciousness (maybe kinder,
gentler) should prevail among us.

I hate to say this: perhaps bioethicists should read the Smith and
Stevens books. The salvos from the right and the left might make us more
attentive to what we are, to what we do and to how we may be perceived.
I continue to believe that the discipline and discourse that was born
some forty years ago is a valid and vital contribution to our
intellectual and social life, but it will continue to be such only by
firm commitment to "the examined life."

References

(1.) M. Talbot, "The Desire to Duplicate," New York Times
Magazine, 4 February 2001; S. Satel and C. Stolba, "Who Needs
Medical Ethics," Commentary, February 2001.

(2.) A. Wolfson, "Are You a Person or a Nonperson? The New
Bioethicists Will Decide," Review of Wesley Smith, Culture of
Death, Wall Street Journal, 24 January 2001.

(3.) D. Callahan, personal communication, 28 January 2001.

(4.) A.R. Jonsen, The Birth of Bioethics (New York: Oxford
University Press, 1998); D. Rothman, Strangers at the Bedside: A History
of How Law and Bioethics Transformed Medical Decision Making (New York:
Basic Books, 1991).

(5.) See ref. 2. Wolfson, "Are You a Person or a
Non-person?"

Albert R. Jonsen is emeritus professor of ethics and medicine at
the University of Washington. He is author of A Short History of Medical
Ethics (Oxford University Press, 2000).